John and the list,
I am sorry to reply this late, but have been away and then tied up, and
I don't recall seeing any answer to this thread.
What is wrong with basing medical care on empirical evidence? In the
late 1700's bleeding was thought to be efficacious. In 1830, Dr. Louis
in France showed empirically that it was not, and it stopped being
useful. We have a never ending list of therapies that "ought to be
good" and seem to be good for an individual patient (take
antiarrhythmics for acute MI as an example) and then when studied in
populations, turn out to be junk (or in that case, killers). I think we
physicians need to reevaluate our view about empiricism.
Dan
****************************************************************************
Dan Mayer, MD
Professor of Emergency Medicine
Albany Medical College
47 New Scotland Ave.
Albany, NY, 12208
Ph; 518-262-6180
FAX; 518-262-5029
E-mail; [log in to unmask]
****************************************************************************
>>> John Barclay <[log in to unmask]> 09/16/2004 5:21:19 PM >>>
Dear James Osborne
Thank you for clarifying the origin of the acronym "EBM".
Are you sure it is still the same today?
I would have thought "EBM" as meaning "Empirically Biased Medicine".
This seems a more appropriate translation of the acronym, given the role
of NICE in the UK (and also some European institutions) in providing
practice guidelines and recommendations which appear to be driven more
by the limitation of costs to political entities than by improving
outcomes for individual patients...
Sincerely.
Dr John Barclay.
----- Original Message -----
From: Osborne, James
To: [log in to unmask]
Sent: Thursday, September 16, 2004 7:10 PM
Subject: Re: evidence based medicine [MeSH]
Jon
The quick (but maybe not that explanatory) answer is as follows;
----------------------------
EVIDENCE-BASED-MEDICINE
Scope Note
The process of systematically finding, appraising, and using
contemporaneous
research findings as the basis for clinical decisions.
Evidence-based
medicine asks questions, finds and appraises the relevant data, and
harnesses that information for everyday clinical practice.
Evidence-based
medicine follows four steps: formulate a clear clinical question from
a
patient's problem; search the literature for relevant clinical
articles;
evaluate ( critically appraise) the evidence for its validity and
usefulness; implement useful findings in clinical practice. The term
"evidence based medicine" (no hyphen) was coined at McMaster Medical
School
in Canada in the 1980's to label this clinical learning strategy,
which
people at the school had been developing for over a decade. (From BMJ
1995;
310:1122).
----------------------------
This information is taken from the expansion note attached to the
MESH
Heading taken from the NHS-Dialog system. The MESH term was
introduced in
1997.
Also of interest is how the other bibliographic databases handle the
term.
For example, Cinahl had a term PROFESSIONAL-PRACTICE-RESEARCH-BASED
used
from 1997 to 2000, then replaced by the term
PROFESSIONAL-PRACTICE-EVIDENCE-BASED from 2000 to 2002, when they
split the
terms into MEDICAL-PRACTICE-EVIDENCE-BASED and
NURSING-PRACTICE-EVIDENCE-BASED. Cinahl's 'definition' of
MEDICAL-PRACTICE-EVIDENCE-BASED is 'Medical practice that bases
clinical
decisions on research, clinical expertise, patient choices, and
critical
evaluation of the literature'.
Whatever the bibliographic database, because we know (anectodatally?)
that
the practice of MESH mapping and similar can occasionally be less
than
perfect, that's why good searchers will complement their use with
sensible
text-word searching.
To really answer your question, I suspect you'll need to tap a NLM
librarian.
James Osborne
Clinical Effectiveness Coordinator
United Bristol Healthcare NHS Trust
Bristol
-----Original Message-----
From: Jon Brassey [mailto:[log in to unmask]]
Sent: 16 September 2004 17:31
To: [log in to unmask]
Subject: evidence based medicine [MeSH]
Does anyone know the criteria that the NLM uses to assign the
"evidence
based medicine" MeSH term?
Best wishes
jon
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